The old Jack Russell had more black and red skin spots - to follow up

Tuesday, Dec 23, 2014

The busy working lady owner of this 11-year-old male neutered Jack Russell complained that the dog's skin disease was not cured despite 2 consultations with my associate vet. "The Z/D is ineffective," she said. I asked her to show me the images of the skin diseases in her handphone.

"The red circular spots and more black circular spots are suggestive of ringworm infections," I said.
"You are in human resources and will know the diversity of human personalities," I explained. "Vets have their own findings and conclusions about skin diseases which can be due to many causes. Environmental cause such as food allergies, contact with chemicals are some causes."





"Does ringworm affect people?" she asked.
"Yes," I said. "Some people develop red rashes on their hands and lap and even chest where the dog had contact after being hugged or carried."
"I had itchy rashes on my right wrist and had to consult the doctor," she said. "It took some time to heal with antibiotics and other drugs."
"It was probably ringworm," I said. "Did you have rashes on your lap too?"
"Yes! yes!" she said.
"On your chest area?"
"No, I don't hug my dog."


"Ringworm is hard to confirm sometimes. Negative findings of hairs may not mean there is no ringworm. I need to review the dog this Sunday morning."

"Can the black spots disappear?" she asked.
"They are due to hyperpigmentation as a result of you applying some cream  for many weeks," I said.
"I didn't do it," she replied.
"Some long-time licking by the dog or lotion or wash," I said. "Black skin pigments migrate to the infected areas."

"Does the dog go to the groomer?" I asked as sometimes ringworm is contacted by grooming with infected blades and scissors.
"Yes, just last month," she said.


I need to follow up this case to determine whether it is ringworm.  

1151. A strange dog owner. Calcium oxalate crystals in the urine

This man brought in his dog's urine sample for analysis of bladder stones as a follow up.  I had advised earlier but he did not come.

Before I could say further about the presence of calcium oxalate crystals in the urine, he said: "I will go to this vet practice. They have all equipment to check my dog for calcium oxalate.  The practice's staff phoned me about "calcium oxalate." 

I told her to get her vet to X-ray for urinary stones and to test the dog with all the equipment as that was what he wanted. A strange dog owner who had not wanted to hear any advices on the urine test. 

The practice with all the equipment will definitely be more attractive to dog owners.

1150. Recurrent struvite urolithiasis: A Westie X had a fully packed bladder full of stones again

In May 2013, the Westie was operated by Dr Daniel and a few thousand small stones were removed. Stone analysis showed struvite stones.  However, the owner did not come back for review. She bought some S/D from her source and then fed Hills' Ideal Balance Natural Lamb and Brown Rice Adult age 1-6 years dry dog food.

Recently the dog passes blood in the urine. The bladder X-ray from another vet yesterday showed it was packed to the gills with bladder stones. The other vet sampled the urine and stated the pH was 8.0 but did not check for urinary crystals. The vet proposed surgery and feeding of S/D cans.

handphone image from owner. Vet had given him a CD. This image does not show the kidneys which may have stones.
The dog had excellent appetite (stools in intestines). Loves to eat.  Image below is from the handphone. Appearance of stones after surgery quite likely struvites. 

  The stones were in more than 1000 pieces and weighed 87 grams. 


SURGERY ON DEC 23, 2014

I share my surgical experiences with this dog
The owner brought in the dog in the morning and was operated in the afternoon at 4 pm. The other vet had said urine pH was 8.0 and lots of white blood cells, but had not done urinary crystal tests.

The surgery took 92 minutes as the dog did not accept IV drip or injection without hard struggles. She peed and pooped in the process. I decided to give the sedation by IM using domitor 0.2 ml + ketamine 0.25 ml in one syringe. The dog struggled again after intubation and I had to switch to the gas mask and stabilise her.  This took up a lot of time. I injected atropine 0.5 ml and fursemide 1.0 ml IM after sedation.  

She was an old dog and a high anaesthetic risk.  She had survived one bladder stone removal operation 1.5 years ago and now, another similar one with the bladder packed with stones.  I could see the bladder wall thickened to 5 mm from the X-ray and this meant that the dog had chronic cystitis. Surprisingly this dog was still active and eating.

I flushed out any smaller stones. Usually I do two layers of sutures for bladder closure. I did 3 layers for this thickened wall. The dog was given drip SC post-op and peed a lot of urine after that. This showed that the bladder was not leaking.

As at Dec 24, 2014, some 18 hours after surgery, the dog is OK. This type of fully packed bladder is rare from over 100 cases operated at Toa Payoh Vets in my past 30 years of practice.

From sedation to the last stitch, the surgery took 92 minutes (E-A).  The first skin incision to last stitch (E-D) took 69 minutes. Isoflurane gas was given for 77 minutes (C-B). 

CONCLUSION
Visualise what you need. Get all equipment ready e.g. 20-ml syringes to flush out the small bladder stones, so as to minimise anaesthetic and operating time.

ADVICE TO OWNER ON DEC 24, 2014
The owner wanted the dog home on the 2nd day. Advices to prevent recurrences are:
1. S/D for 2-3 months
2. Change to C/D
3. Urine test monthly for 3 months at least with your vet
4. X-rays bladder and kidneys 6 monthly
5. No other food and treats 

Dec 27, 2014  2 pm. Tel owner.
Dog crated to prevent running around apartment. Active, ate 1/2 can S/D and wanted more. Had pooped. Very thirsty and peed a lot. No vomiting. Licks wound which is wet (but wears E-collar) and vulval area.
Had medication and tolfedine 60mg (1/2 tab/day).
Advised not too much water intake as bladder is affected. Ration to 1/2 bowl of water 3x/day. Previously drinks around 1 bowl of water per day.
Keep wound clean. 1/2 can S/D 2x/day. To call me when necessary.

--------------------------------------------------------------------------------------------------------------------------FLASHBACK-

FIRST SURGERY IN MAY 21, 2013 DONE BY DR DANIEL

STONE ANALYSIS ON MAY 21, 2013

MAP (Magnesium Ammonium Phosphate). However, the owner did not come back once for review or consulation.  One and a half years went by.......The dog was active and had an excellent appetite. Drinking was normal. But she passed blood in the urine and vomited once yesterday (Dec 22, 2014). Another vet took an X-ray and it showed a bladder full of stones.


She  quoted around $1,800 for surgery. The parents wanted Toa Payoh Vets to operate. To reduce medical costs, no stone analysis would be done. Blood test and urine tests were declined.

An old male Miniature Schnauzer cannot control his bladder

Dec 18, 2014

The not neutered 10-year-old Schnauzer could not control his bladder for the past 1 week.
"Very smelly urine," the husband said. "He has bad breath for a long time."
I palpated the lower mid abdomen. The dog winced in pain. "Schnauzers are famous for urinary stones," I advised x-rays, blood and urine tests. The client permitted x-rays and urine tests only.

No urinary stones seen but the urine had occasional triple phosphate crystals and bacteria. Diagnosis was urinary tract infection.The dog recovered his bladder control after antibiotics. I post a urine test reminder card one month after the first test but much depends on the owner as some ignore such veterinary advices. Usually vets don't have time to send such reminders too.

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COMPARE TO THE 7-YEAR-OLD SHIH TZU WITH BLADDER TUMOUR AND URINARY STONES. The dog was operated by Dr Daniel on Dec 21, 2014 yesterday. Today at 6pm, he barked when the owners came to visit. The owners did not want surgery 2 years ago in mid 2012, when X-rays showed small stones, opting for dietary dissolution.

"6 cans of prescription diet S/D will not dissolve the stones," I explained. "The dog ought to have 3 months of S/D for 2012 and urine tests and monitoring with X-rays."  It is difficult to convince owners that they have to comply with vet instructions as they find that the dog's urine was OK with feeding of S/D 6 cans.

1148. Not cured but did not come for monthly review

Poodle 6 years   muzzle, neck, ears v. itchy and bleeding. UVL +ve ringworm. Did not come back after Aug treatment. Just go to groomer and buy shampoo and anti-allergic Z/D diet from another vet nearby.

Generalised ringworm and other bacterial infections are not easy to cure. It needs daily washes and compliance with medication. Owners need to be educated as they assume medication will cure the disease. There is the environmental contamination, the towels, bedding, flooring and dog shirts which may be contaminated with ringworm spores. The dog must be clipped bald. Ear problems may involve ringworm too.

I hope this poodle will get proper home treatment and get cured.

1147. The friend saved the English Cocker Spaniel's life - tick fever anaemia

"How do you know that your friend's English Cocker Spaniel has such a big medical file?" I asked the lady who brought in a cat with 10 ingrown toe nails.

"Dr Daniel remarked that Amber's medical records are like an encyclopedia!" she replied.

1146. A 7-year-old Shih Tzu has bladder tumour and many stones.

Sunday Dec 21, 2014

This 7-year-old male, not neutered Shih Tzu, born Feb 19, 2007 got his three vaccinations from me as a puppy. On Jun 29, 2012,  he passed blood in the urine for 2-3 weeks and lost appetite. The owners said was fed only rice and wet food and did not want surgery when X-ray showed bladder stones and urine showed triple phosphate crystals +, bacteria 3+ and blood 4+ , protein 2+. pH was 7.0. SG 1.015.

Dr Daniel advised surgery. The owner wanted conservative treatment using a special diet to dissolve the stones. She bought 6 cans of prescription diet S/D for the next 12 months. This is not the correct way to dissolve the stones. The S/D diet must be fed solely for 3 months and urine tests (monthly) and X-rays (3-6 monthly) need to be done.  The owner did not comply.


BLOOD TEST  22.12.14
Urea 8.5 (4.2-6.3). Creatinine  79 (89-177).  Haematology was normal and this was a good sign for surgery as there was little or no bacterial infections or septicaemia. 

URINE TEST
pH 7.0  SG 1.01. Nitrite +, Blood 4+, Bacteria 2+, no crystals.



Today, Sunday, Dec 21, 2014, the owner consented to the surgery as the dog was peeing blood in the urine for several weeks.

Now the catheter cannot pass into the bladder as urethral stones at the bend of the urethra obstructed the passage of the catheter. I palpated the bladder. It was still solid as a golf ball but not fully obstructed. The dog surprisingly had an appetite.  An IV drip with antibiotics, pain-killers and Vit Bs is given now and surgery was by Dr Daniel in the afternoon.

A globular submucosal bladder tumour 2.5 cm x 2.5 cm x 2 cm was surprisingly found. Many small stones with some sticking in clumps,  looking like calcium oxalate uroliths were taken out. 

CONCLUSION
Many Singapore owners are not aware that medical dissolution of triple phosphate stones need to be monitored regularly with urine tests and X-rays.  In this case, the owner bought 6 cans of prescription S/D in 2012 when the stones were found in the bladder and assumed all stones will be dissolved since they fed rice and wet food.

S/D must be fed 3 months followed by C/D and there must be regular urine tests and X-rays.
   

1145. Images for perineal abscess, ear abscess etc

The maid came with the dog as he was scratching both ears and shaking his head.

1. Painful ear infections and head shaking for over 10 years with hair loss on neck skin and pigmentation in ear pinnae. The owner did not want sedation and ear irrigation and the husband wanted the dog back and sent to another vet.

 

 

 

 

 

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1. Intense perineal pain of 2 days. "Looks like a perineal hernia," I said as the dog wanted to bite. "Right anal sac area intensely inflamed."
   
   BLOOD TEST
   Creatinine 33 (89-177) not significant.
   Total WCC 23.2 (6-17), N 96% (60-70), Absolute 22 (3-11).
   Hb 11.4 (12-18). RBC 4.7 (5.5-8.5).

Given IV drip + baytril + dexa on Day 1.
Went home. Came back on Day 2 for X-rays. A skin hole appeared near the right anal sac area now. Over 100 ml of reddish brown blood with yellow materials shot out. So, this is a perineal abscess. Based on blood test, there was lots of bleeding.  

 

 

 

 

 

 

 

 

 

 

 

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1144. Unbelievable vet stories - foreshadow

"I wonder whether my dog has the same anal problem as me," the owner saw the dark red bruised right anal area. "My GP diagnosed piles but it was extremely painful. I could not sit. I drove mtself to tge private hospital and was operated upon. Anal abscess. Excruciating pain."
Her dog had a very painful backside. It was a rare perineal abscess/haematoma.

Blood tests showed lower than normal red blood cells and haemoglobin suggesting that there was a big amount of bleeding in the right backside area. A big blood vessel must have been infected and ruptured. A very unusual case.

The dog had bladder stones seen on the X-rays but not causing any urinary problems. The owner said she had gall bladder stones removed recently. So she commented that she better look after her health as her dog had similar illness after her.   

1143. A dwarf hamster had left upper lip tumour operation - 2 weeks later

Dec 17, 2014

I was surprised that the hamster did survive and was active as a large portion of his left upper lip with intra-lip tumour 3mm x 3mm was electro-excised by Dr Daniel 2 weeks ago.

The wife and their 2 children were concerned about the swollen right eye which happened after the upper lip tumour excision, doing self-treatment without success for last 14 days.
"Let the hamster pass away on its own without treatment' the father reiterated but the family would ignore him.

"This hamster had a few operations," he started his videoing today. "He had a toe amputated, facial tumours removed, ear canal warts and the upper lip tumour cut off by you. No Singaporean hamster owner would bother to get the dwarf hamster operated for so many conditions. Let Nature take its course and do nothing now."  

From my medical records, the following was done on this hamster aged around 2 years as at Dec 17, 2014

1. Feb 22, 2014. Left fore second digit toe abscess lanced. Five balls of right facial abscesses lanced.  Body weight 67 g. Inactive on exercise wheel.

2. Apr 24, 2014.     Left fore second digit toe tumour  amputated. Five right facial abscess electro-excised.  Body weight 61 g. Inactive on exercise wheel.

3. Jun 6, 2014. Right vertical ear canal filled with warts. Electro-excised. Vertical ear canal ablation. 63 g. Advised reduce weight.

4. July 20, 2014.  Four right facial tumours electro-excised.

5. Nov 22, 2014   Left upper lip swelling and ulceration. Clip overgrown lower teeth. 46g now.

6. Dec 3, 2014. Let upper lip tumour electro-excised.  38 g.

7. Dec 17, 2014. Clip lower front teeth. Right eyelids itchy and swollen last 14 days. Left upper lip ulceration need cleaning.